Surgery has been found to be more effective and cheaper than insulin for patients with type 2 diabetes.
The groundbreaking research has also revealed surgery can free the majority from future use of insulin.
Research co-ordinated by the Irish Society for Clinical Nutrition and Metabolism (IrSPEN) and the British Obesity and Metabolic Surgery Society analyzed the post-surgery outcomes of nearly 2,000 patients with obesity and diabetes requiring insulin.
Professor Helen Heneghan from the National Metabolic Surgery Centre at St Vincent’s University Hospital, said 67pc of patients were no longer using insulin one year after metabolic surgery, and 37pc achieved remission of their diabetes altogether.
“On average patients also lost around a quarter of their body weight and the improvements persisted for at least four years,” said Professor Heneghan.
The research included patients across Ireland and the UK and analyzed their outcomes between 2009 and 2017.
Professor Heneghan said gastric operations are well established as the most clinically and cost-effective treatment for most patients with early or mild diabetes, but the question remained if surgery would be as effective for patients with type 2 diabetes requiring insulin – as these patients also have a higher chance of diabetes complications, such as blindness, kidney failure, limb amputation, and heart disease.
“This research now confirms metabolic surgery is also the most effective medical treatment for the majority of patients with more severe type 2 diabetes who use insulin,” she said.
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In a second part of the study IrSPEN member Professor Carel le Roux who also works at the Metabolic Surgery Centre at St Vincent’s said surgery was also found to be more cost effective than medication:
“The researchers costed the surgery against if the same patients had been treated with medicines alone. Although an operation costs €8,000, researchers found that this figure was less than the ongoing cost of medications.
“With costs of treatment side-effects and any complications of diabetes were also considered, the average patient treated with surgery was expected to save the health system €4,000 over five years, while also living with better health outcomes.”
Professor le Roux told Independent.ie that the health system benefitted, and so too did the patients.
“You can just imagine, if you are somebody who has to inject yourself every day, typically these patients inject themselves twice or three times a day, you have to worry about having low blood sugar, and hypoglycemia, monitoring yourself, just how that really impairs your quality of life,” he pointed out.
"So if you can now go back, and suddenly no longer need insulin and have better control, that is a massive quality of life gain for these patients.”
He said that there are other benefits too including better blood pressure control and reduced kidney disease.
The types of operations carried out would have included a gastric by-pass which had the best results in this survey, a gastric sleeve, and gastric band.
Dubliner Laurence Kelly (57) a patient needing daily insulin injections for his type 2 diabetes for many years, no longer requires these injections after his operation.
“These findings show the benefits of the HSE making metabolic surgery more widely available to more public patients in Ireland. The surgery not only gave me significant improvement in my health, but is also cost-effective for the HSE within a short payback time,” he said.
Ireland’s public health system has the lowest funding per capita for obesity treatment in the EU.
In France, 40 times more gastric surgeries per head of the population are carried out compared to in Ireland.